Brief Outline of Stress Fracture to the Foot

Stress fractures in the foot are usually a result of repetitive impact to the bones of the feet. Running or jumping on hard surfaces, changing the duration or distance of workouts too quickly, or fatigued muscles that can no longer absorb shock can lead to small cracks in the bone. The small cracks accumulate and become a stress fracture.

Anatomy and physiology

A stress fracture can occur in any of the bones of the foot but are generally seen in the metatarsals. The heel bone, or calcaneus, can also become fractured with improper footwear or as the result of an old injury that has gone untreated. The bones subjected to repetitive trauma develop minor cracks and then these cracks build on each other leading to a stress fracture. A weak point in the bone from a previous injury or due to bone rebuilding can lead to stress fractures under normal stress conditions.

Cause of Stress Fracture to the Foot

Repetitive trauma to the bones of the foot. Weakened area of bone due to previous injury or other condition. Muscle fatigue, making the muscles ineffective shock absorbers.

Signs and symptoms

Pain at the site of the fracture. Pain with weight bearing, with inability to walk in severe cases. Swelling may be noted over the fracture site. Some loss of foot function may be noted.

Complications if left unattended

More serious stress fracture including a complete break in the bone may occur if left unattended. Swelling and inflammation may cause blood flow and nerve problems in the foot. Pain may increase to the point of disability and inability to walk.


  • R.I.C.E
  • Anti-inflammatory medications
  • Observe and monitor
  • See a doctor if not better

Rehabilitation and prevention

Strengthening of the muscles that support the foot will help to lessen the impact on the foot, with stronger muscles absorbing more shock. A gradual start to activity after the injury has healed is important to prevent recurrence. Proper footwear, correct warm-up techniques, avoiding hard running surfaces and a diet with calcium-rich foods will help prevent stress fractures in the foot.

Long-term prognosis

Stress fractures will usually heal completely and have no lingering effects if rest and rehabilitation are used. The fracture site should heal to become stronger than it was originally. Only in severe cases where the bone fractures completely and does not respond to rest and immobilisation, will surgery be required.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to check your stress fracture to your foot today.

Brief Outline of Tibia Stress Fracture

Tibial Stress Fracture

Repetitive impact activities, such as running and jumping, can cause small cracks in the bone called stress fractures. These most often occur in the weight bearing bone, the tibia, of the lower leg. Athletes with lower bone density, due to dietary issues or genetic predisposition, are more susceptible, as are athletes who train on hard surfaces at increased distance and duration. Women are more susceptible to this injury than men due to bone density deficiency conditions such as irregular or absent menstrual cycles, eating disorders or osteoporosis.

Anatomy and physiology

The tibia (shin bone) is the larger and more medial of the bones in the lower leg. At the proximal end, the medial and lateral condyles articulate with the distal end of the femur to form the knee joint. The tibia tuberosity is a roughened area on the anterior surface of the tibia. The tibia is the weight bearing bone of the lower leg and therefore takes a large amount of the force of impact during running and jumping activities. This force is transferred up the length of the bone. Bones are constantly repairing and rebuilding, leading to the robbing of calcium from one area of the bone to build another, causing a weak area. When the impact is transferred up the shaft and encounters a weak area, due to either calcium deficiency or a prior stress fracture, the bone will crack slightly. Overtime, this leads to a more serious crack or fracture. Fatigued muscles also contribute to the possibility of stress fractures. The muscles are meant to take some of the shock away from the bones but a fatigued muscle is a poor shock absorber.

Cause of Stress Fracture

Repetitive stress on the bone through impact activities such as running or jumping. Low bone density. Muscle fatigue leading to lower shock absorption by the muscles.

Signs and symptoms

Pain with weight bearing, worsens with activity and diminishes with rest. Pain is most severe at the early stage of activity, subsiding in the middle and returning at the end. Point tenderness and some swelling possible.

Complications if left unattended

If left stress fracture unattended, a stress fracture can become a complete fracture and lead to complications such as bleeding and nerve compromise. The pain from an untreated stress fracture may lead to a complete cessation of activity and further injury to surrounding tissues.


  • Anti-inflammatory medication.
  • Shockwave therapy
  • Seek medical help if any instability is noted in the lower leg, or inability to bear weight.

Rehabilitation and treatment

During the recovery phase, it is important to maintain fitness levels by using low or non-impact activities such as swimming or biking. Strengthening the muscles of the lower leg will help add extra shock absorption. Warming-up properly and using cross training techniques to limit the impact of the bone will help prevent stress fractures.

Long-term prognosis

Stress fractures generally heal completely with rest. Returning to activity too soon may cause a recurrence. Very rarely surgical intervention may be needed to strengthen the bone at the fracture site.

Call (+65) 6471 2674 to fix an appointment to see our doctor to treat Tibia Stress Fracture today.

Joint Pain

Brief Outline of Medial Tibial Pain Syndrome – Shin Splints

Shin Splints

Shin splints are a common complaint of runners and other athletes who have just taken up running. Shin splints are actually a term used to cover all pain in the anterior shin area. There are several possible causes. Medial tibial pain syndrome, the most common cause of shin pain, refers to pain felt over the shin bone from irritation of the tendons that cover the shin and their attachment to the bones. Changes in duration, frequency or intensity of running can lead to this condition.

Anatomy and physiology

The tibialis anterior muscle originates from the lateral condyle of the tibia, and inserts into the medial and plantar surfaces of the medial cuneiform bone. Tibialis anterior is responsible for dorsiflexing and inverting the foot and is used frequently during running to toe up with each step. When the muscle and tendon becomes inflamed and irritated through overuse or improper form, it will cause pain in the front of the shin. Repetitive pounding on the lower leg, such as with running, can also lead to pain in the shin.

Cause of Shin Splints

Repetitive stress on the tibialis anterior muscle leading to inflammation. Repetitive pounding force on the tibia, as with running and jumping.

Signs and symptoms

Dull, aching pain over the inside of the tibia. Pain is worse with activity. Tenderness over the inner side of the tibia with possible slight swelling.

Complications if left Shin Splints unattended

If left unattended, shin splints can cause extreme pain and cause cessation of running activities. The inflammation can lead to other injuries, including compartment syndrome.


Rehabilitation and prevention

It is important to use low impact activities, such as swimming or cycling, to maintain conditioning levels while recovering. Stretching of the tibialis anterior muscle will help with recovery. To prevent this condition from developing, try alternating high impact activity days with lower impact days. It is also important to strengthen the muscles of the lower leg to help absorb the shock of impact activities.

Long-term prognosis

Medial tibial pain syndrome can be effectively treated with no long-term effects. Only in rare cases does the condition fail to respond to rest and rehabilitation, leading to chronic inflammation and pain. Surgery may be required in those rare cases.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat Shin Splints today.

There are several locations of stress fracture in the foot, but there is only one type that atheletes can identify themselves. Metatarsal stress fractures are common and can often be self diagnosed. The pain is located on the shaft of the metatarsal behind the joint. It is usually felt on top, but may be deep inside.

The pain is usually reproduced by pressing on the metatarsal bone from the top. Bend the toe downward and note how the knuckle responds. The pain can be 1/2 inch to about 2 inches behind this joint. If the pain is anywhere else it is not a classic stress fracture.

After about 2 weeks a bump can usually be felt on the metatarsal in the location of pain.

Description of Pain in the Foot

Stress fracture can occur without knowing it. The pain can begin after a workout, during the first part of the next workout, or after sitting and sleeping.

The pain can also begin during a workout, sometimes in a very short period of time. The pain can become strong. This type of stress fracture is easier to identify because it is obvious, but it also usually means the damage is greater.

Many times there can be a low grade ache that does not really hurt much for as long as a week or two, only to become quickly more sore and obvious. This is usually the time that a stress syndrome becomes a true stress fracture.

The pain is described as an ache, sometimes piercing.

The pain can vary from the mildest form that only hurts with exercise, to intense pain that forces one to use crutches for walking.

Cause of Stress Fracture of the Foot

  • Excessive intensity of workouts prior to the body adapting.
  • A singular event that exceeds the current level of the skeletal and muscular fitness of the athlete.
  • Poor bone density – Osteoporosis.

Treatment for Stress Fracture of the Foot


If the foot hurts too much to walk with a normal gait, an X-ray is strongly advised to rule out a complete fracture.

A cast is not usually needed for mild to moderate stress fractures unless the pain prevents normal activity. Fortunately this pain is also an indicator of the extent of the fracture. More pain means a more severe fracture. A doctor will know how to make the foot more comfortable.

Consequences of Running / Walking Through the Pain

Progression of the injury is probable. A mild stress fracture can become a complete fracture.

Many athletes who are training for a significant goal decide to take the risk and run with a mild stress fracture (moderate or severe fractures are too painful). Some make it through, but many aggravate the injury, requiring a lot more rest. Unfortunately, a mild stress fracture can become a serious true fracture within 2 – 3 strides.

Call (+65) 6471 2674 (24 hr) to see our orthopaedic specialist regarding your stress fracture today.

Shin Splints

What is Shin Splint (Medial Tibial Stress Syndrome)?

Shin Splints
Shin Splints may develop in the muscles in the front and outer parts of the shin

Shin splint is the symptom of pain over the front of the tibial bone.

What are the Causes?

Shin splints are normally due to overuse. When the overuse causes irritation to the tendons and the attachment of these tendons to the bone, the condition is called medial tibial stress syndrome. It is commonly seen in athletes who suddenly increase their duration or intensity of training.

What are the Treatments?

The treatments are applying ice packs or perform ice massage for up to 20 minutes three times a day, take anti-inflammatory medication prescribed by a doctor, or perform rehabilitation exercises regularly e.g. swimming and cycling.